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Infection control and prevention guidelines for influenza in long term care and residential care facilities.

Infection Control and Prevention Guidelines
for Influenza in Long Term Care and
Residential Care Facilities
Public Health
Fact Sheet
Public Health
Fact Sheet
Residents in nursing homes and other residential facilities have a higher risk of complications due to respiratory infections such as influenza. Disease-causing organisms can enter a facility through personnel, residents, or visitors. It is important to identify these illnesses early so actions can be taken quickly to control the spread.
Modes of Influenza Transmission:
Influenza viruses are spread by close contact with infected people through these routes: Droplet transmission occurs when respiratory droplets from infected persons directly fall within 3–6 feet (may be up to 10 feet) from the infected person during breathing, talking, coughing, sneezing, or singing. Contact transmission occurs when droplet material is picked up from contaminated surfaces and items in the infected person’s surroundings, then indirectly spread by touching others or by touching one’s own eyes, nose, or mouth. Influenza can survive up to 12 hours on cloth, paper, and tissues, and up to 48 hours on hard non-porous surfaces such as stainless steel and plastic. It can also survive up to 5 minutes on hands. Airborne transmission occurs when respiratory droplets are aerosolized (i.e., during procedures like bronchoscopy, intubation, cardiopulmonary resuscitation [CPR], open airway suctioning, and sputum induction) or when the droplets evaporate and can be easily moved by airflow effects. Airborne transmission may be increased during outbreak situations.
Actions to Prevent and Control Influenza:
1. Annual influenza vaccine for employees and residents is strongly recommended. Infected people may have very mild symptoms - or none at all - but they are still able to spread influenza to others.
2. Be alert for early signs of influenza-like symptoms in employees and residents. (See page 3 regarding employees.) Screen and monitor new residents and those returning after temporary absences. Instruct and remind residents to report symptoms promptly, especially fever, cough, sore throat, headache, or body aches. When a resident is suspected of having influenza:
a. Isolate any resident with influenza-like illness from others. Residents should stay in their own rooms until at least 24 hours after they are free of fever or signs of a fever without the use of fever-reducing medications. Residents should not participate in any group activities during this time. Residents with influenza-like symptoms may keep their roommates. These roommates are already exposed, so monitor them closely for development of illness. Use appropriate personal protective equipment and precautions (see page 2).
b. If a resident with influenza-like illness must leave their room for any reason, place a surgical or procedure mask on them. If wearing a mask compromises the resident’s ability to breathe easily, others near them should wear a mask during this time. Instruct and monitor respiratory hygiene and hand hygiene at all times (see next page). Separate symptomatic residents from others by at least 3-6 feet if they must be outside their room.
c. Consult with the facility physician regarding use of antivirals when influenza is suspected or confirmed. Antivirals are most effective when given within 48 hours of onset of symptoms. Antivirals can make the illness milder, shorten the duration of illness, and prevent complications.
3. Educate residents and employees to follow respiratory hygiene, cough etiquette, and hand hygiene and ensure adequate supplies of tissues, waste containers, and hand hygiene materials. Cover mouth and nose with a tissue when coughing or sneezing, OR cough or sneeze into the upper sleeve, NOT into one’s hands. Put used tissues into a waste basket immediately. Wash hands with soap and water or use alcohol-based hand cleaner afterwards.
Influenza-like-illness (ILI) is defined as fever* and a cough and/or a sore throat in the absence of another known cause of illness.
*temperature of 100°F (37.8°C) or greater
page 1 of 3

Infection Control and Prevention Guidelines
for Influenza in Long Term Care and
Residential Care Facilities
Public Health
Fact Sheet
Public Health
Fact Sheet
Residents in nursing homes and other residential facilities have a higher risk of complications due to respiratory infections such as influenza. Disease-causing organisms can enter a facility through personnel, residents, or visitors. It is important to identify these illnesses early so actions can be taken quickly to control the spread.
Modes of Influenza Transmission:
Influenza viruses are spread by close contact with infected people through these routes: Droplet transmission occurs when respiratory droplets from infected persons directly fall within 3–6 feet (may be up to 10 feet) from the infected person during breathing, talking, coughing, sneezing, or singing. Contact transmission occurs when droplet material is picked up from contaminated surfaces and items in the infected person’s surroundings, then indirectly spread by touching others or by touching one’s own eyes, nose, or mouth. Influenza can survive up to 12 hours on cloth, paper, and tissues, and up to 48 hours on hard non-porous surfaces such as stainless steel and plastic. It can also survive up to 5 minutes on hands. Airborne transmission occurs when respiratory droplets are aerosolized (i.e., during procedures like bronchoscopy, intubation, cardiopulmonary resuscitation [CPR], open airway suctioning, and sputum induction) or when the droplets evaporate and can be easily moved by airflow effects. Airborne transmission may be increased during outbreak situations.
Actions to Prevent and Control Influenza:
1. Annual influenza vaccine for employees and residents is strongly recommended. Infected people may have very mild symptoms - or none at all - but they are still able to spread influenza to others.
2. Be alert for early signs of influenza-like symptoms in employees and residents. (See page 3 regarding employees.) Screen and monitor new residents and those returning after temporary absences. Instruct and remind residents to report symptoms promptly, especially fever, cough, sore throat, headache, or body aches. When a resident is suspected of having influenza:
a. Isolate any resident with influenza-like illness from others. Residents should stay in their own rooms until at least 24 hours after they are free of fever or signs of a fever without the use of fever-reducing medications. Residents should not participate in any group activities during this time. Residents with influenza-like symptoms may keep their roommates. These roommates are already exposed, so monitor them closely for development of illness. Use appropriate personal protective equipment and precautions (see page 2).
b. If a resident with influenza-like illness must leave their room for any reason, place a surgical or procedure mask on them. If wearing a mask compromises the resident’s ability to breathe easily, others near them should wear a mask during this time. Instruct and monitor respiratory hygiene and hand hygiene at all times (see next page). Separate symptomatic residents from others by at least 3-6 feet if they must be outside their room.
c. Consult with the facility physician regarding use of antivirals when influenza is suspected or confirmed. Antivirals are most effective when given within 48 hours of onset of symptoms. Antivirals can make the illness milder, shorten the duration of illness, and prevent complications.
3. Educate residents and employees to follow respiratory hygiene, cough etiquette, and hand hygiene and ensure adequate supplies of tissues, waste containers, and hand hygiene materials. Cover mouth and nose with a tissue when coughing or sneezing, OR cough or sneeze into the upper sleeve, NOT into one’s hands. Put used tissues into a waste basket immediately. Wash hands with soap and water or use alcohol-based hand cleaner afterwards.
Influenza-like-illness (ILI) is defined as fever* and a cough and/or a sore throat in the absence of another known cause of illness.
*temperature of 100°F (37.8°C) or greater
page 1 of 3